Gastroparesis case study (2)
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Gastroparesis case study (2)

on

  • 1,100 views

 

Statistics

Views

Total Views
1,100
Views on SlideShare
1,100
Embed Views
0

Actions

Likes
0
Downloads
17
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • Picture retrieved from: http://www.sciencephoto.com/media/309804/enlarge
  • EGG - electrogastrography
  • “Any insult to gastric smooth muscle control may be accentuated in women,” because of their higher level of progesterone.
  • Picture from:http://www.acupuncturerichmondva.com/images/Stomach-Pain.jpg
  • Image from : http://www.medscape.com/viewarticle/460632_4
  • Question retrieved from: http://wps.prenhall.com/chet_wagner_highacuity_4/40/10330/2644649.cw/content/index.html
  • Question retrieved from: http://wps.prenhall.com/chet_wagner_highacuity_4/40/10330/2644649.cw/content/index.html

Gastroparesis case study (2) Presentation Transcript

  • 1. GastroparesisNiccole CouseUniversity of South FloridaCollege of Nursing
  • 2. Introduction (1)• Gastroparesis is “delayed gastric emptying inthe absence of a mechanical obstruction.”• Commonly caused by autonomic neuropathy– Other causes are stress, infection, post-op• Occurrence in “0.01%” of men and “0.04%” ofwomen.– “36-49%” Idiopathic– “25-29%” Diabetes mellitus– “7-13%” Post surgical• Prognosis depends on the cause
  • 3. Pathophysiology (2)• HealthyThe interstitial cells of Cajal of thestomach are stimulated by the Vagusnerve to contract, which churns anddigests food and stimulatesperistalsis.
  • 4. Pathophysiology (2)• Disease stateIn gastroparesis the stomach does notcontract so food will sit in thestomach for longer than normal.The main cause is usually neuropathy!– The stomach does not get the signal tocontract
  • 5. Diagnosis (1)• Gastroparesis can only be diagnosedafter mechanical obstruction is ruled out– Endoscopic and radiologic techniques used.• MRI, Ultrasound, EGG– Scintigraphy is “gold standard” for diagnosis• Ingest “radiolabelled meal” and check for residueat certain times• “Positive if more than 60% residual ingested mealcontent is detected within the stomach after 2 h,or more than 10% residual content is detected at4 h.”
  • 6. Risk Factors (2)• Diabetes– Diabetic neuropathy• Female– Higher Progesterone• Reduces smooth muscle activity• Viral infections– Certain viruses can lead to damage to thestomach
  • 7. Signs and Symptoms• Persistent nausea andvomiting• GERD• Constipation anddiarrhea• Abdominal pain• Bloating• Anorexia• Unintended weightloss• Inconsistent bloodglucose levels
  • 8. Treatments (1)• Dietary management– Dietary consult with patient– Evauate best tolerated foods– Reduce meal size and smaller pieces offood– Low fat (liquid if needed)– No alcohol or carbonated beverages– Fiber consumption is debated• Most agree that insoluble fiber should beavoided
  • 9. Treatments• Medications– Prokinetic drugs (1)• Metoclopramide• Erythromycin• domperidone– Botulinum toxin injections (Botox) (1)• Relaxes smooth muscle• Injected into pyloric sphyncter allows foreasier passage of food into the duodenum
  • 10. Treatments• NG/NJ tube placement– If dietary changes and medications areineffective than an NG/NJ tube may beplaced to provide nutrition• Parenteral nutrition– May be considered– Weigh the risks of infection andthrombosis
  • 11. Treatments• Surgery– PEG-J tubes (1)• Allows food to skip the stomach• Relievs symptoms• Improves nutritional status in “83%” of patients– Gastric pacemaker (3)• Electrical stimulation of the stomach• High frequency stimulation is shown to reducenausea and vomiting• Low frequency stimulation is shown to increasemotility and peristalsis
  • 12. Gastric Pacemaker
  • 13. Prognosis (4)• Many people with gastroparesis areable to live normally with long-termprokinetic therapy• Patients with gastroparesis caused bydiabetes often require a more seriousintervention along with prokinetictherapy
  • 14. Clinical Example• Admission Dx: intractable vomiting• Other diagnoses:– Gastroparesis– Chronic gastritis– Barrett esophagitis– Fibromyalgia– hyperthyroidism
  • 15. Clinical Example• HPI:– 40y white female– Has been experiencing persistent nauseaand vomiting for the past six months• Throws up at least once a day– Complains that she “can’t keep anythingdown”– Patient states that the nausea is constant– Patient denies any aggravating factors– Patient smokes marijuana and cigarettes
  • 16. Clinical Example• Medications– 0.9%NaCl IV– Pregabalin – pain– Baclofen – pain/fibromyalgia– Omeprazole – healing of erosive esophagitis– Milnacipran – fibromyalgia management– Odansetron – nausea prevention– Lorazepam – anxiety• Current therapies– Full liquid diet– Strict monitoring of I & O– Vitals Q6H– Glucose monitoring at meal time
  • 17. Assessment• Inspect– Swelling, abdominal distention, tenderness– Fluid output– Daily Weights• Auscultate– Presence of bowel sounds• Percuss– Tympany• Palpate– Pain, tenderness, masses
  • 18. Nursing Diagnosis• Risk for deficient fluid volume• Impaired nutrition: less than bodyrequirements• Risk for electrolyte imbalance
  • 19. NCLEX style question• A client with diabetes has beendiagnosed with gastroparesis. Thenurse realizes this is considereda) A long-term complication of diabeticneuropathy.b) A symptom of microvascular diseasec) A precursor to long-term woundinfections.d) A precursor to renal failure
  • 20. NCLEX style question• A client with diabetes has beendiagnosed with gastroparesis. Thenurse realizes this is considereda) A LONG-TERM COMPLICATION OFDIABETIC NEUROPATHY.b) A symptom of microvascular diseasec) A precursor to long-term woundinfections.d) A precursor to renal failure
  • 21. NCLEX style question• Which of the following treatmentswould NOT be appropriate for a clientwith gastroparesis?a) Botulinum Toxin injectionb) Bowel diversion surgeryc) NJ tube feedingsd) Gastric Electrical Stimulation/Pacemaker
  • 22. NCLEX style question• Which of the following treatmentswould NOT be appropriate for a clientwith gastroparesis?a) Botulinum Toxin injectionb) BOWEL DIVERSION SURGERYc) NJ tube feedingsd) Gastric Electrical Stimulation/Pacemaker
  • 23. References(1) Athwal, V., Keld, R., Kinsley, L., & Lal,S. (2011). Pathogenesis, investigation and dietaryand medical management of gastroparesis. Journal of Human Nutrition andDietetics, volume 24(issue5). DOI: 10.1111/j.1365-277X.2011.01190.x(2) Buckle D.C. Treatment of Gastroparesis in the Age of the Gastric Pacemaker: GastricElectrical Stimulation. Retrieved fromhttp://www.medscape.com/viewarticle/460632(3) Lin,Z. Forester, J. Sarosiek, I. & McCallum, W. Treatment of Gastroparesis with ElectricalStimulation. Digestive Diseases and Disorders, volume 48(issue5). DOI DOI:10.1023/A:1023099206939(4) Rayner, C. & Horowitz, M. New Management Approaches for gastroparesis. Medscape.Retrieved from http://www.medscape.com/viewarticle/514206_8